Reading of the Week: Antidepressants after Acute Coronary Syndrome and Depression – A Lifesaver? The New JAMA Paper

From the Editor

State-of-the-art care for acute coronary syndrome includes oxygen and clot-busting drugs. Should it also include a depression screen and an antidepressant if necessary?

In this week’s Reading, we look at a new JAMA paper showing a response to escitalopram for patients post-ACS (Acute Coronary Syndrome) with depression. Though work has been done in this area before, this paper is an important contribution: it’s well designed, and offers a long follow-up period. Chonnam National University Medical School’s Jae-Min Kim and his co-authors conclude: “In this median 8.1-year follow-up of a randomized 24-week clinical trial of treatment for depression in patients with recent ACS, MACE [major adverse cardiac event] incidence was significantly lower in patients receiving escitalopram than those receiving placebo.”

We consider the paper and its implications.

norm_2xGood EKG, good antidepressant?

Please note that there will be no Readings for the next two weeks.

DG
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Reading of the Week: Mental Illness & Crime Victimization – the New JAMA Psychiatry Paper

From the Editor

After the mass shooting on Toronto’s Danforth, mental illness has been much in the news. The Canadian Psychiatric Association went so far as to warn against stigmatizing those with mental illness.

Despite stereotypes, studies show that people with mental disorders are more likely to be victims of violent crime rather than perpetrators. That said, the literature is light on how much crime patients experience, and the diagnoses of these patients.

This week, we look at a new paper just published by JAMA Psychiatry. Drawing on databases from Denmark, the University of New South Wales’ Kimberlie Dean and her co-authors consider crime (including violent crime) in a cohort study involving more than two million people. What do they find? Those with mental illness are much more likely to be victims than the general population.

gettyimages-126140612_superDenmark: old buildings and not-so-old data

In an accompanying editorial, Duke University School of Medicine’s Jeffrey W. Swanson and Charles M. Beldendiscuss the paper, and contrast it with American data. Their piece begins memorably: “The media-driven notion that mentally ill people pose a danger to others appears to be encrusted like a barnacle on the concept of mental illness submerged in the public mind.” They also weigh in on difference in rates of violence between Denmark and the United States.

DG

 

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Reading of the Week: Suicide Notes & Lessons Learned – the New CJP Paper; Also, Mukherjee on Case Reports

From the Editor

Many people didn’t write one. But some did. The notes were usually short, typically only 600 words or so, and were often handwritten. Some talked about their illness; others didn’t.

What lessons can we learn from these suicide notes?

In the first selection, University of Toronto psychiatry resident Dr. Zainab Furqan and her co-authors consider notes left by those who suicided in a paper just published in The Canadian Journal of Psychiatry. They argue that we can learn from them, and offer clinical suggestions.

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In the second selection, Columbia University’s Dr. Siddhartha Mukherjee argues that the obscure is relevant – he notes the decline and fall of the case report, and calls for its return.

DG

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Reading of the Week: Common Medications and the Link to Depression – the New JAMA Psychiatry Paper

From the Editor

“Many may be surprised to learn that their medications, despite having nothing to do with mood or anxiety or any other condition normally associated with depression, can increase their risk of experiencing depressive symptoms, and may lead to a depression diagnosis.”

JAMA Psychiatry papers rarely make international news. A new paper by the University of Illinois’ Dima Mazen Qato (who is quoted above) and her co-authors has, however. In looking at prescribed drugs like proton pump inhibitors, they find that many are linked to depressive symptoms. One online news report began with the headline: “37% of US Adults Are Using Common Meds They Don’t Realise Could Cause Depression: It’s even worse if you use several medications together.”

It’s a big study with a big result. For the record, a couple of patients have already brought up the findings with me.

statin_2819148bMany small pills, one big problem?

What to think and how should it affect patient care? In this week’s Reading, we consider the paper.

DG

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Reading of the Week: Higher Volume, Better Care? The Rasmussen Paper

From the Editor

How do we improve mental health services?

Past Readings have explored many topics from measurement-based care to better access. This week, we consider a new paper by Aalborg University’s Line Ryberg Rasmussen et al. The study authors look at volume and quality of mental health care, drawing on Danish inpatient admissions.

Their finding? “This nationwide, population-based cohort study demonstrated that patients with depression who were admitted to psychiatric hospitals with very-high-volume wards were more likely to receive care in accordance with clinical guidelines, compared with those admitted to low-volume wards.”

ptelemnursing01High volume, better care (if not better cafeteria food)?

This week, we look at the Rasmussen et al. paper and consider its implications.

DG

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Reading of the Week: Marijuana Policy After Legalization; Also, Remembering Charles Krauthammer

From the Editor

Last week, the Senate voted 52 to 29 in favour of Bill C-45, clearing the last hurdle for marijuana legalization. The federal government is aiming for implementation in the fall.

So, what now?

In the first selection, the University of Toronto’s Tony P. George et al. discuss a “framework” for cannabis policy post-legalization. This Canadian Journal of Psychiatry perspective paper is prescriptive, aiming to reduce the negative effects of the legal change. They make six recommendations, including a national strategy for education.


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Also, in this week’s Reading, we consider the life and psychiatric contributions of Charles Krauthammer, who died last week at age 68. Dr. Krauthammer is best known for his political commentary, but he had a career in psychiatry before becoming a prominent essayist, and penned a classic paper on “secondary mania.”

Please note that there will be no Reading next week.

DG

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Reading of the Week: Smoking Cessation & Incentives – the NEJM Paper

From the Editor

“So to put it simply, forcing people to choose is not always wise, and remaining neutral is not always possible.” University of Chicago economist Richard H. Thaler and Harvard Law School Professor Cass R. Sunstein write this comment in their widely-read book Nudge: Improving Decisions about Health, Wealth and Happiness. They argue that people could be nudged in a certain direction, improving outcomes. Among the book’s fans: former UK Prime Minister David Cameron and former US President Barack Obama.

Thaler and Sunstein write about shaping basic decisions, like encouraging people to choose among their company’s pension plans. Retirement planning can significantly help people with their finances in their twilight years. But what about substance use? The stakes seem higher: smoking cessation can prevent major health problems long before retirement.

This week, we look at a new paper by University of Pennsylvania Perelman School of Medicine’s Dr. Scott D. Halpern and his co-authors. Published in The New England Journal of Medicine, they consider smoking cessation and find “financial incentives added to free cessation aids resulted in a higher rate of sustained smoking abstinence than free cessation aids alone…”

file-20170804-6503-18ujgw6Nudging people to butt out?

In this week’s Reading, we consider the paper and its implications. (There is, however, no financial incentive offered here.)

DG

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Reading of the Week: On Spade, Suicide, and the New CDC Report

From the Editor

“I didn’t know Kate Spade, who hanged herself with a red scarf in her bedroom on Tuesday at the age of 55, other than through the prism of her insistently cheerful and whimsical accessories. But everything about Ms. Spade and her designs suggested a sunny temperament, from her candy-colored aesthetic to the perky image she projected. We have a hard time squaring a seemingly successful woman — one with a highflying career, a family and heaps of money — with a despondency so insinuating that it led her to end it all. All this helps explain why Fern Mallis, the former director of the Council of Fashion Designers of America and a friend of Ms. Spade’s, called her death ‘so out of character.’ In fact, it turned out that the bubbly girl from Kansas City ‘suffered from depression and anxiety for many years,’ as her husband, Andy, said.”

So writes novelist Daphne Merkin The New York Times. In the essay, Merkin writes about her depression and her own suicidal thoughts.

Kate Spade. Then Anthony Bourdain.

It’s been a remarkable few days.

bourdain-obama-429e2fd0-b412-4a22-804a-acb7a25d8d43Anthony Bourdain with President Barack Obama

In this Reading, we look at the new CDC report on suicide in the United States. Suicide rates south of the 49thparallel have risen nearly 30% since 1999. We consider the paper and its implications.

DG

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Reading of the Week: Alastair Campbell on his Brother, his Life and his Schizophrenia

From the Editor

“So, my schizophrenia story. Well, the story is mine, but the schizophrenia was Donald’s. He would happily have told you his story himself, for he was very proud of the life he led, given the seriousness of the condition. Sadly, he can’t, as he is dead. So I will tell his story instead.”

Alastair Campbell is many things. He is the author of more than a dozen books. He is a former press secretary and director of communications for UK Prime Minister Tony Blair. He is the father of three.

And he’s the brother of a person who had schizophrenia.

In this week’s Reading, we consider his speech for the Schizophrenia International Research Society, “The Shittiest of all the Shitty Illnesses.” He discusses his brother’s illness and its impact on his family – and he also talks about his brother.

stream_imgAlastair Campbell

In this Reading, we consider Campbell’s comments, and also the larger issue of reduced life expectancy for those with severe mental illness.

DG

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Reading of the Week: Can Computerized CBT Help People with Substance Problems? The New AJP Paper. Also, How Many People Really Have Mental Illness?

From the Editor

More than ever, we are talking about substance use problems. But as with other mental health services, people struggle to get care, particularly evidence-based therapies.

In the first selection, we consider a new paper from The American Journal of Psychiatry, published last week. Yale University’s Brian Kiluk and his co-authors compare traditional CBT (done with a therapist and in-person) with a computer-based therapy program, CBT4CBT. They conclude: “This computerized version of CBT thus appears to be an engaging and attractive approach for persons with substance use disorders.”

typingTyping to Treat Substance Use?

In the second selection, we consider an essay by The Globe and Mail’s André Picard who asks a simple question: How many people actually suffer from mental illness? Picard cautions us on “pathologizing normal emotions.”

DG

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